Physiological performance of two contrasting rice varieties under water stress.

Two rice varieties PR-115 and Super-7 were imposed to water stress and different physiological traits were monitored to evaluate the performance of these varieties under drought. Under water stress condition although the relative water content, osmotic potential, chlorophyll content, photosynthesis rate, carbon discrimination and biomass decreased in both the varieties however, the reduction was more pronounced in Super-7 variety. Oryzanol a trans-ester of ferulic acid functions as antioxidant and it increased along with total phenolic and anthocyanin content in both the varieties under drought stress. However, gallic acid, 4 hydroxy benzoic acid, syringic acid and chlorogenic acid showed differential pattern in both of the varieties under water limiting conditions. Under drought, grain yield was penalized by 17 and 54% in PR-115 and Super-7 varieties, respectively in comparison to watered plants. Super-7 variety showed pronounced electrolyte leakage and MDA enhancement under water stress condition. High non photochemical quenching and reduction in Y(NO) and Y(II) indicated balanced energy management in tolerant PR-115 variety. The studies showed that PR-115 is a drought tolerant variety while Super-7 is drought sensitive in nature.

Prevalence and Correlation between MRI Findings and Outcome of Conservative Treatment in Primary Idiopathic Frozen Shoulder.

Objectives: Primary idiopathic frozen shoulder (FS) causes pain and stiffness in the shoulder joint. Over time, this disease causes restriction of shoulder motion. We undertook this study to evaluate possible correlation of MRI findings with outcome of conservative management in FS. Methods: A total of 65 cases participated in prospective cohort study. The correlation of MRI findings obtained before commencing the treatment with outcome of non-operative management (Mean of ROM, VAS, SST and OSS) was evaluated. Results: Anterior extracapsular edema significantly correlated with FF, EXR, VAS (a) and OSS. The effusion in humeral side of axillary recess significantly correlated with ROM restriction in ABD, EXR. Capsular thickness of glenoid portion showed good significance with FF, ABD, VAS (a) and OSS. Increased thickness of CHL showed negative correlation with improvement of EXR (P=0.049) (r=-0.617). Thickening of IGHL showed negative correlation with improvement of ABD (p=0.005 r=-0.862) and FF (p=0.007 r=-0.831). Mean Height of Axillary recess (HAR) was 7.2mm (3.5-11mm). HAR showed negative correlation with VAS pain scale (P=0.036) (r=-0.682) and OSS (P=0.038) (r=-0.668). Conclusion: Thickness of the joint capsule and effusion at the axillary fold are important factors for refractory frozen shoulder. We can recommend MRI for refractive cases and low threshold of expectation can be set for conservative management in patients with above findings.

The Advantages of 4-rod Construct over the 2-rod Techniques in Adult Spinal Deformity Patients who Underwent Pedicle Subtraction Osteotomy: A Multicenter Retrospective Comparative Study.

OBJECTIVE: In this retrospective study we compared clinicoradiologic outcomes and complication profiles of the traditional 2-rod construct versus the 4-rod construct in patients with adult spinal deformity (ASD) who underwent pedicle subtraction osteotomy (PSO). METHODS: We performed a retrospective review of 208 ASD patients at 2 referral centers who underwent lumbar PSO and long fusion from thoracic to the pelvis. Two different techniques, including the 4-rod construct and the traditional 2-rod technique, were used at the PSO level. Clinicoradiologic outcomes and complication profiles of the patients were documented and compared statistically between the groups. RESULTS: The 4-rod construct was associated with statistically lower rates of rod fracture (44.8% vs. 26.4%, P < 0.01), pedicular screw loosening at the PSO level (25.3% vs. 14.0%, P = 0.04), and reoperation (49.4% vs. 33.9%, P = 0.02). Radiologically, the 4-rod construct was associated with higher degree of lumbar lordosis (LL) (-37.4°vs. -26.8°; P < 0.01) and improved pelvic tilt (PT) (-17.2° vs. -9.9°; P < 0.01) and sacral vertical axis (SVA) corrections (-211.5° vs. -192.2°; P = 0.04). Overall, the 4-rod construct was associated with improved quality of life (P = 0.04) and statistically lower Oswestry Disability Index score at 12 months postoperatively (P < 0.01). CONCLUSIONS: Our results showed that the 4-rod construct was associated with statistically lower rates of rod fracture and pedicular screw loosening at the osteotomy level, higher degree of LL correction and improved PT and SVA than the 2-rod technique. The 4-rod construct was also associated with improved quality of life and Oswestry Disability Index and lower complication profiles.

Neurolymphomatosis as an Initial Presentation of Non Hodgkins Lymphoma: A Case Report.

Neurolymphomatosis (NL) is a rare clinical disease where neoplastic cells invade the cranial nerves, roots, plexus, or other peripheral nerves in patients with hematologic malignancy mainly Non-Hodgkins Lymphoma(NHL). Primary NL occurs as the first manifestation of a hematologic malignancy. We report a 68-year male who presented to us with low backache and burning paraesthesia in the back of both lower limbs followed by a left foot drop. The clinical and electrophysiological examination was suggestive of bilateral lumbosacral radiculopathy involving L2-S1 roots. Plain MRI of the lumbosacral spine was normal. F18FDG PET CT Scan revealed increased uptake in both L5 and left L3 roots. Contrast-enhanced MRI of the lumbosacral spine showed marked fusiform thickening and enhancement of both L5 and left L3 roots CT-guided Biopsy from left L5 root, lymph node, and bone marrow was suggestive of large B cell lymphoma-germinal center cell type. The diagnosis was neurolymphomatosis secondary to NHL.

The Impact of Rigid Cervical Collars on Outcome of Patients Who Underwent Posterior Cervical Laminectomy and Fusion: A Retrospective Comparative Study.

STUDY DESIGN: Retrospective cohort study. PURPOSE: This study aimed to investigate the cervical collar impact on the functional outcomes of patients after posterior cervical laminectomy and lateral mass screw fixation (PCLF) surgery. OVERVIEW OF LITERATURE: The safety and possible benefits of implementing rigid cervical collars subsequent to PCLF are insufficiently investigated. METHODS: Patients who underwent PCLF and received postoperative cervical collars from 2018 to 2020 were included in this retrospective cohort study. Their data were compared with an age- and sex-matched group of subjects who did not receive collars after PCLF during the same period. Pain intensity (using the Visual Analog Scale), Neck Disability Index, and quality of life (using 36-item Short Form Health Survey) of the patients were compared at baseline, 1, 3, 6, and 12 months postoperatively. RESULTS: A total of 36 patients who received cervical collars after surgery and 40 controls were included. At baseline and 1-month follow-up, there were no differences in pain intensity, functional status, and quality of life between the groups. However, at 3 months postoperatively, the quality of life of the subjects with no orthosis was higher than those who received cervical collars (p =0.01). At 6- and 12-month follow-up, there were no differences between the groups in pain intensity, functional status, and quality of life. CONCLUSIONS: No difference in the pain intensity and functional status of patients who used cervical collars and controls was shown in our study. Patients who did not wear cervical collars had a higher quality of life during the 3-month postoperative evaluation. Future prospective, well-controlled studies with longer follow-ups are needed to further investigate the effects of cervical orthosis on the clinical outcome of patients after PCLF.

Clinicoradiological Outcomes and Complication Profiles of Bilateral Dual Sacral-Alar-Iliac Screws versus Bilateral Single Sacral-Alar-Iliac Screws in Patients with Spinal Deformity Who Underwent Grade 3 or 4 Spinal Osteotomies: A Retrospective Comparative Study.

OBJECTIVE: To compare short-term clinical and radiological outcomes and complication profiles between bilateral dual sacral-2-alar-iliac (S2AI) screw and bilateral single S2AI screw fixation techniques in patients who underwent grade 3 or 4 spinal osteotomies. METHODS: A retrospective review of 83 patients treated with bilateral dual S2AI screws and 32 patients treated with bilateral single S2AI screws was conducted between 2018 and 2020 with a minimum 1-year follow-up. Clinical and radiological outcomes of patients and incidence of perioperative complications, including rod breakage, screw dislodgment, proximal junctional kyphosis, proximal junctional failure, need for reoperation, and systemic adverse effects, were collected and statistically compared between the groups. RESULTS: With a mean follow-up of 18.2 months, rod fracture (6.0% vs. 18.7%, P = 0.03), screw dislodgment (0 vs. 12.5%, P < 0.01), and S2AI screw loosening (1.2% vs. 18.7%, P < 0.01) were significantly lower in the dual S2AI screws group than in the single S2AI screws group. However, the reoperation rate was similar between the 2 groups (24.1% vs. 34.3%, P = 0.26). No significant differences in clinical and radiological outcomes as well as proximal junctional kyphosis (10.8% vs. 18.7%, P = 0.25) and proximal junctional failure (9.6% vs. 18.7%, P = 0.18) were identified between the 2 groups. CONCLUSIONS: The dual S2AI screw fixation technique showed more advantages over the single S2AI screw fixation technique with reduced incidence of screw dislodgment, rod fractures, and sacral-alar-iliac screw loosening.

Reliability and validation of Turkish version of the Dallas Pain Questionnaire.

OBJECTIVES: Evaluation of low back pain (LBP) requires a condition specific disability questionnaire along with pain and satisfaction measure such as self-assessment pain scales. Dallas Pain Questionnaire (DPQ) is a 16-item visual analog scale, developed for evaluating patient's cognitions about the percentage that chronic pain affects four aspects of the subject's lives. It's easy to understand; can be answered in 3-5 min and can be scored in <1 min. This reliability and validation study offers health-care providers an opportunity to utilize this distinct questionnaire in Turkish population with back pain. The objectives are translation of Dallas questionnaire from English to Turkish language and to perform validation and reliability study. METHODS: A total of 102 patients (79 women and 23 men) with mean age of 50.2 years and LBP for at least 3 months answered DPQ along with five other previously translated and validated questionnaires in Turkish language. Fifty-nine of these patients participated retest reliability after 7 days. Internal consistency and test-retest analyzes were conducted to determine the reliability and convergent validity was evaluated for the validation study. RESULTS: The questionnaire was noted to have high internal consistency. The test-retest analysis revealed an excellent correlation (ICC=0.969). Pearson correlation coefficient shows that all subscales (sections) of DPQ are significant and comparable with each of the other questionnaires included in this study proving that it has sufficient convergent validity (p<0.001). CONCLUSION: The Turkish version of DPQ is content, valid, and reliable. DPQ is sensitive to use in patients with LBP.

Pulmonary Manifestations In Patients With Rheumatoid Arthritis Visiting Tertiary Care Hospital.

Background: Rheumatoid arthritis is a common problem in elderly individuals. It is reported that lung involvement in these patients is widely present. This study was done with the purpose to assess the burden and characteristics of lung involvement in rheumatoid arthritis patients attending rheumatology clinic. Methods: This descriptive cross-sectional study, in which data was retrospectively collected, was carried out from April 2019 to December 2020 at the Rheumatology Department of Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan. All adult rheumatoid arthritis individuals, irrespective of gender or duration of disease, were consecutively enrolled. Information regarding the baseline characteristics, medication history for rheumatoid arthritis, findings of immunological tests along with the frequency of lung involvement and its pattern were observed. Results: Of 254 patients, the mean age was 37.46 ±12.39 years. Females were predominantly higher as compared to males, i.e., 232 (91.3%) vs. 22 (8.7%) respectively. Current smoking status was found positive in 7 (2.8%) patients. The mean disease duration was 4.41±3.96 years. Furthermore, frequency of pulmonary manifestation was observed in 45 (17.7%) patients. A significantly higher mean difference of age (p-value <0.001) and disease duration (p-value <0.001) was observed among patients with and without pulmonary manifestation. Moreover, a significant association of current smoker was also observed with pulmonary manifestation. Conclusion: A considerable number of patients with rheumatoid arthritis had pulmonary manifestation. Furthermore, a significant relationship was observed with age, duration of disease, and current smokers.

Acute Onset Flaccid Paraplegia with Monocular Diminution of Vision in a Case of Chikungunya Infection.

Chikungunya is a common tropical viral infection in India. The majority of patients have limited systemic manifestations. Neurological manifestations of chikungunya may be due to direct viral infection or immune mediated. We present a case of a 45-year-old male who presented with acute onset paraplegia with diminution of vision in the right eye. A detailed evaluation revealed a diagnosis of chikungunya myeloradiculitis with viral keratitis. The patient was treated with steroids followed by intravenous immunoglobulin and had a good recovery.

Novel transthyretin gene mutation in familial amyloid neuropathy in India: Case.

Familial amyloid polyneuropathy (PN), also known as amyloid transthyretin (TTR)-PN is an autosomal dominant adult-onset fatal disease, if not treated. It occurs due to mutations in (TTR) gene which leads to a faulty TTR protein which folds up to form amyloid and gets deposited mainly on nerves and causes length-dependent PN and autonomic dysfunction. We report a case of a 45-year-old female who presented with symptoms of painful peripheral neuropathy for 5 months, a history of deafness for 5 years, and cardiac pacemaker implantation 2 years ago for complete heart block. She denied any symptoms of autonomic dysfunction. Her brother with similar symptoms died of cardiac arrest at the age of 50 years. Clinical examination was suggestive of symmetrical sensorimotor PN. The nerve conduction study was suggestive of axonal sensorimotor PN. Abdominal fat biopsy was negative for amyloid. Sural nerve biopsy was suggestive of amyloid neuropathy. Genetic analysis showed c. 165G > T mutation encoding amino acid p. Lys55Asn on exon-4 of TTR gene. This mutation has not been reported from India.

Résumé La polyneuropathie amyloïde familiale (NP), également connue sous le nom de transthyrétine amyloïde (TTR) -PN, est une maladie mortelle autosomique dominante de l'adulte, si elle n'est pas traitée. Il se produit en raison de mutations du gène (TTR) qui conduisent à une protéine TTR défectueuse qui se replie pour former de l'amyloïde et se dépose principalement sur les nerfs et provoque une PN dépendante de la longueur et un dysfonctionnement autonome. Nous rapportons le cas d'une femme de 45 ans qui présentait des symptômes de neuropathie périphérique douloureuse depuis 5 mois, des antécédents de surdité depuis 5 ans et l'implantation d'un stimulateur cardiaque il y a 2 ans pour un bloc cardiaque complet. Elle a nié tout symptôme de dysfonctionnement autonome. Son frère présentant des symptômes similaires est décédé d'un arrêt cardiaque à l'âge de 50 ans. L'examen clinique évoquait une NP sensorimotrice symétrique. L'étude de la conduction nerveuse était évocatrice d'une NP sensorimotrice axonale. La biopsie de la graisse abdominale était négative pour l'amyloïde. La biopsie du nerf sural était évocatrice d'une neuropathie amyloïde. L'analyse génétique a montré c. Mutation 165G > T codant pour l'acide aminé p. Lys55Asn sur l'exon-4 du gène TTR. Cette mutation n'a pas été signalée en Inde. Mots clés: Neuropathie amyloïde familiale, tests génétiques, biopsie nerveuse, amylose à transthyrétine.

An exceptional case of posterior shoulder fracture dislocation in patient with recurrent anterior dislocation forming "Mirror Hill-Sachs lesion".

A posterior dislocation should be always kept in mind in a painful shoulder especially after trauma or seizure. Even in the presence of recurrent dislocation, the direction may be different from one episode to another.

Physiological attributes associated with leaf spectral alterations in guar [Cyamopsis tetragonoloba (L.) Taub.] under drought.

Two contrasting guar varieties [Cyamopsis tetragonoloba (L.) Taub.], RGC-1002-a better drought tolerant than RGC-936-a comparatively sensitive variety, were subjected to 8 days of water stress. The physiological characteristics of gas exchange, pigments and the spectral properties of the leaves were monitored and assessed. The guar variety, RGC-1002 exhibited higher relative water content (RWC) and biomass accumulation in water stress condition as compared to RGC-936. The RGC-1002 variety also showed a higher rate of photosynthesis, stomatal conductance, and lesser reduction in chlorophyll content as compared to RGC-936 variety. On the 8th day of drought, the leaf anthocyanin levels were also higher in RGC-1002 than RGC-936. Increased levels of anthocyanin result in decrease in absorption of light, and an increase in reflectance, and transmittance. The scattering coefficient of leaf spectra was significantly increased in RGC-936 than in RGC-1002 leaves; this is due to an increase in the size of intercellular air spaces and shrinkage of cells as a result of water loss. The leaf reflectance was also observed to be significantly increased in RGC-936 than in RGC-1002 leaves. The physiological and leaf optical observations substantiate that RGC-1002 was better adapted to water stress than RGC-936 variety. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13205-021-02674-2.

Contamination and Decontamination of Autologous Bone in the Operating Room: A Systematic Review.

OBJECTIVE: To perform a systematic review of the literature to determine the rate of contamination of autologous bone fragments inadvertently dropped on the operating room floor, the microbial profile (contaminating organism), and the outcome of intraoperative decontamination techniques in terms of effectiveness and cellular toxicity. DATA SOURCES: PubMed, Medline, and Embase were searched for English literature published from 1990 through 2020 using terms such as "bone graft contamination," "dropped osteoarticular fragments," "autogenous bone decontamination," and similar interchangeable words. STUDY SELECTION: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Inclusion criteria consisted of all studies on contamination of host bone fragments, means and/or rate of autologous bone contamination in operating rooms, microbial analysis of contaminated bone autograft, outcome of decontamination, and cellular viability after decontamination. DATA EXTRACTION: All potentially eligible studies underwent a full-text review and cross-referencing after title and abstract screening. Data on authors, publication year, study type, means and rate of contamination, microbial profile, decontamination technique, and effectiveness and cellular toxicity outcomes were extracted. DATA SYNTHESIS: Analysis and synthesis of data were performed on Microsoft Excel 2016. CONCLUSION: The rate of contamination for dropped osteoarticular or osteochondral host fragment approached 40%. Staphylococcus epidermidis was the most common organism contaminating the bone graft when dropped on the operating room floor. A 5-minute bath in 10% povidone-iodine solution followed by 1-minute bulb syringe lavage with normal saline has proved successful in decontamination and maintenance of cellular viability. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Metabolic Syndrome In Young Rheumatoid Arthritis Patients.

BACKGROUND: Metabolic Syndrome is strongly associated with Rheumatoid Arthritis, which significantly increases cardiovascular complications and hence morbidity and mortality. Treating Metabolic Syndrome decreases cardiovascular related disease flares and deaths. This study evaluates prevalence of metabolic syndrome in young Rheumatoid Arthritis patients. METHODS: This Cross-sectional study was conducted in rheumatology department of a tertiary care hospital in Karachi. All diagnosed cases of rheumatoid arthritis from April to August 2018 were consecutively included. Disease activity of rheumatoid arthritis assessed by Clinical Disease Activity Index (CDAI). Associate determinants of rheumatoid arthritis were measured along with outcome variables. RESULTS: Out of 104 rheumatoid arthritis patients, 34 (32.7%) found to have metabolic syndrome in whom 20 (58.8%) of patients were seropositive. A significant association of metabolic syndrome was found with age (p-value 0.023), BMI (p-value 0.006), waist circumference (p-value 0.002), FBS (p-value <0.001), SBP (p-value <0.001), DBP (p-value <0.001), TG (p-value <0.001), HDL (p-value 0.022), and Methotrexate drug history (p-value 0.030). CONCLUSIONS: We conclude that metabolic syndrome is highly prevalent in young rheumatoid patients with rheumatoid arthritis. Treating Metabolic Syndrome decreases cardiovascular related disease flares and deaths. This young population base study will help out to estimate the exact burden of Metabolic Syndrome to decrease overall morbidity and mortality.

Association of Severity of Allergic Conjunctivitis with Skin Prick Test.

OBJECTIVE: To investigate the association between skin prick test and severity of allergic conjunctivitis. STUDY DESIGN: Cross sectional observational study. Study Place and Duration of Study: Akbar Niazi Teaching Hospital, Bara Kahu, Islamabad, between March and September 2019. METHODOLOGY: 150 eyes of 150 diagnosed cases of allergic conjunctivitis, who had had a skin prick test, were included in the study. Cases with other concurrent ocular surface diseases, conjunctivitides, systemic allergies, and those on systemic steroids, anti-histamines and tricyclic antidepressant agents were excluded. Signs of allergic conjunctivitis were graded via slit-lamp examination using a 5-5-5 exacerbation grading scale. Allergic conjunctivitis was classified as being severe if the total score was ≥230, moderate if the score was >20 and <230, and mild if the score was ≤20. Frequency distribution was reported for age, gender and result of skin prick test. Test of significance and correlation analysis was carried out between the result of skin prick test and the severity of allergic conjunctivitis using Statistical Package for Social Sciences version 20.0. A p-value of <0.05 was taken as significant. RESULTS: Mean age was 18.62 (±8.15) years in 91 males and 59 females. Mild (n = 28), moderate (n = 77), and severe (n = 45) cases showed no statistically significant correlation with the skin prick test (positive or negative) in any of the three categories (mild p = 0.44, r = 0.153, moderate p = 0.89, r = 0.016, and severe p = 0.73, r = 0.052). CONCLUSION: Skin prick test did not show a significant association or correlation with the severity of allergic conjunctivitis. Key Words: Allergic conjunctivitis, Hypersensitivity, Skin prick test.

Reliability and validation of the Turkish version of the Low Back Outcome Score.

OBJECTIVE: This study aimed to validate the Turkish version of the Low Back Outcome Score and check its reliability in patients with chronic low back pain (LBP). METHODS: Overall, 105 patients (81 women and 24 men; mean age: 49.5 years (18-65 years)) with a complaint of LBP for at least 3 months were included in this study. Test-retest reliability was assessed after 7 days. Overall score of LBOS was compared with the overall scores of "Rolland-Morris Disability Questionnaire," "Oswestry Disability Index," "Quebec Back Pain Disability Scale," "SF-36," and "Bournemouth Questionnaire for Back Pain" to calculate the convergent validity by using Pearson correlation coefficient. RESULTS: The questionnaire was noted to have high internal consistency. The test-retest analysis revealed an excellent correlation (ICC=0.80). Pearson correlation coefficient of the LBOS was assessed using VAS and had an excellent correlation with all the questionnaires included in this study. CONCLUSION: The Turkish version of the LBOS questionnaire appeared to be a valid and reliable outcome measure. LEVEL OF EVIDENCE: Level III, Diagnostic study.

Atypical Multiple Sclerosis with Antibody to MOG.

CASE PRESENTATION: We report a case of a young female who had magnetic resonance imaging (MRI) brain lesions typical of multiple sclerosis (MS) with cerebrospinal fluid (CSF) oligoclonal bands (OCBs) and definite multiple sclerosis based on revised McDonald criteria; however, she also had atypical features of mild pleocytosis, brainstem and cerebellar peduncle involvement apart from opticospinal (OS) involvement. She also turned out to be positive for anti-myelin oligodendrocyte glycoprotein (MOG) antibody; hence, she was diagnosed with atypical multiple sclerosis. This case highlights when to suspect atypical MS and its management approach. DISCUSSION: Typical MS cases are largely anti-MOG-negative. In a study of 50 Japanese cases, with anti-aquaporin 4 (AQP4)-immunoglobulin (IgG)-negative OSMS, just 2 were MOG-IgG-positive, but they had some features atypical for MS, such as bilateral optic neuritis, longitudinally extensive transverse myelitis, or moderate pleocytosis. In another study, antibodies to MOG were found in about 5% (5/104) of preselected adult patients with MS. Patients with MS with antibodies to MOG showed typical MS lesions on brain MRI with concomitant severe brainstem and spinal cord involvement and had a severe disease course with high relapse rates. CONCLUSION: In conclusion, any patient showing typical MS lesions on brain MRI with OCB present in CSF but has atypical features like mild pleocytosis with brainstem, cerebellar, or OS involvement should also be tested for autoantibodies to MOG, and if positive, then he/she would require aggressive treatment approach in the form of plasma exchange, if resistant to pulse steroid therapy, followed by either rituximab or natalizumab rather than trying other disease modifying therapies (DMTs).

Prevalence and Pattern of Pulmonary Manifestation in Patients with Connective Tissue Disorder.

Background A substantial number of deaths and morbidities are caused by pulmonary involvement in connective tissue disorders (CTDs). The majority of patients suffering from CTDs show diverse clinical presentations arising in the lungs, the diaphragm, vasculature, and the pleura during the course of their disease. The clinical course is highly variable ranging from asymptomatic to symptomatic and from reversible to an irreversible stage. The most common occurring pulmonary appearance is the interstitial disease of the lung. In our study, we aim to determine the prevalence and pattern of pulmonary manifestation in patients with CTD presenting at a tertiary care hospital of Karachi, Pakistan. Methods A descriptive cross-sectional study was conducted in the department of Rheumatology Medical Unit II, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan. All patients having CTD were enrolled. Patients with human immunodeficiency virus (HIV) infection, smokers, chronic obstructive pulmonary disease (COPD), bronchogenic carcinoma and patients with underlying cardiac disease were excluded from the study. Pulmonary manifestations like nonspecific interstitial pneumonia (NSIP), pleural effusion, usual interstitial pneumonia (UIP), interstitial pneumonitis, pulmonary arterial hypertension (PAH), tuberculosis, and pulmonary embolism were observed. In addition to this, treatment history and immunological test findings of these patients were also recorded. Results A total of 290 patients with rheumatologic disorders were included in this study, out of which 90.7% (263) were females and the average age of the entire cohort was 35.13 ± 12.53 years. A majority, 71% (206), of the patients were young (≤ 40 years of age). Rheumatoid arthritis (RA) was the most commonly observed rheumatologic disorder in this cohort which was in 70.3% (204) patients. RA was more prevalent in patients above 40 years of age as compared to young patients (≤ 40 years of age) with a frequency of 81% vs. 66%; p=0.012. Pulmonary involvement was observed in 27.2% of the patients while no pulmonary involvement was noted in 72.8% of patients. Conclusion Pulmonary manifestations in patients with CTD is not that uncommon (27.2%). PAH and NSIP collectively account for three-fourth of the total prevalent cases of pulmonary involvement in CTD patients.

Evaluation of the Inter and Intra-Observer Reliability of the AO Classification of Intertrochanteric Fractures and the Device Choice (DHS, PFNA, and DCS) of Fixations.

BACKGROUND: ArbeitsgemeinschaftfürOsteosynthesefragen (AO) classification is the most frequently used tool to classify intertrochanteric fractures. However, there is limited evidence regarding its reliability. Therefore, this study was designed to evaluate inter-observer and intra-observer reliability of the AO-2018 intertrochanteric fracture classification. METHOD: A retrospective study was conducted in Imam Khomeini Hospital Complex, on radiography of patients who came with intertrochanteric fractures from March 21, 2018, to March 19, 2019. Four orthopedic trauma surgeons assessed 96 anteroposterior pelvic radiographs of intertrochanteric fractures and classified using an AO intertrochanteric fracture classification of 2018. The reading and review of radiography were performed in 2 separate occasions in a 1-month interval. The inter-observer and intra-observer reliability was assessed using kappa statistics. RESULT: The level of both mean inter-observer (K =0.322; 95%CI: 0.321-0.323) and intra-observer agreement (K =0.317; 95%CI: 0.314-0.320) in AO intertrochanteric fracture classification subgrouping were not satisfactory. The inter-observer (K =0.61; 95%CI: 0.608-0.611) and intra-observers' (K=0.560; 95%CI: 0.544-0.566) reliability in AO main groupings showed moderate agreement. CONCLUSION: The AO classification does not show adequate and acceptable inter-observer and intra-observer reliability and reproducibility. Therefore, it will be hard to base on the AO classification for treatment protocols.

Pars Plana Vitrectomy for Resistant Cystoid Macular Edema.

OBJECTIVE: To evaluate the results of pars plana vitrectomy for cystoid macular edema (CME) resistant to medical treatment. STUDY DESIGN: Quasi-experimental study Place and Duration of Study: Al-Shifa Trust Eye Hospital, Rawalpindi, from January to July 2019. METHODOLOGY: This study recruited 30 eyes of 30 patients with cystoid macular edema confirmed on optical coherence tomography that was refractory to medical treatment. Eyes with diabetic fibrous proliferation, optic atrophy, neo-vascular glaucoma, membrance and macular retinal pigment epithelial atrophy were excluded from the study. All patients underwent 23 G pars plana vitrectomy followed by epiretinal membrane / internal limiting membrane (ERM/ILM) peeling and gas injection. In 11 eyes, perfluoropropane gas was injected; while in 19 eyes, sulfurhexafluoride gas was injected. Main outcome measures included pre- and post-op Snellen's visual acuity and central macular thickness (CMT). All patients completed their follow-up of six months. RESULTS: Mean age of 16 male and 14 female patients was 54.30 ±3.70 years. Postoperative Snellen's visual acuity improved to 0.61 ±0.08 from 0.11 ±0.04 and postoperative central macular thickness improved to 223.80 ±40.20 µm from 578.00 ±26.57 µm. Both differences were statistically significant (p<0.001). CONCLUSION: Pars plana vitrectomy with ERM / ILM peel and gas injection for CME refractory to medical treatment is an effective treatment. There was significantly improved best corrected visual acuity (BCVA) postoperatively along with decreased CMT on optical coherance tomography (OCT).